Proxy
Know all persons by these present, that I, the undersigned, a member of the Jackson County Democratic Committee, duly elected from the __________ Ward/Sub-district, __________________ Township, do hereby constitute and appoint the bearer, __________________________ (bearer’s full name) to be my lawful attorney substitute and proxy at the ________________________meeting to be held on the __________day of _____________, 20___, at (location) _____________________, Missouri at _________ o’clock, and at any adjourned or postponed meeting thereof, and hereby grant my proxy full power and authority to act in my stead, and with the same effect, as I might or could do were I present in such meeting in person, and hereby ratify and confirm all that my said attorney or proxy may lawfully do at such a meeting in my place or stead.
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Committee Member Signature
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Ward/Sub-district/Township
This document must be notarized unless you have signed the signature file held by the Secretary. A maximum of two (2) proxies may be tendered at any one (1) meeting by any committee member.
7/7/09
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